Healthwatch Bath and North East Somerset: Issues and Concerns

Healthwatch Bath and North East Somerset: Issues and Concerns

Year 2 Quarter 2: July – October 2014

Healthwatch Bath and North East Somerset has heard 45 issues and concerns from health and social care service users, carers, family members, and service providers since July 2014.

This report considers the types of comments and the services they relate to, and the themes emerging from the issues and concerns heard between July and October 2014 (Q2).

Sources of Comments

Healthwatch Bath and North East Somerset uses several channels through which it hears issues and concerns about health and social care services from the public (see Graph 1).

In Q2, the most commonly used method of capturing service users’ feedback was responses to a survey, which was carried out as part of a special inquiry into hospital discharge.

Sentiments of comments

The sentiments of the service feedback heard by Healthwatch Bath and North East Somerset are shown in Graph 2:

Comment types

Graph 3 shows the issues and concerns heard by Healthwatch Bath and North East Somerset, according to the type of comment. Some stories could be categorised by more than 1 type of comment.

The most often-heard types of issue and concern in Q2 related to discharges (19 in total, 3 mixed, 16 negative).

Service types

Graph 4 shows the issues and concerns heard by Healthwatch Bath and North East Somerset, according to the service they refer to. Some stories could be categorised by more than 1 type of service.

The most commonly referred-to service in Q2 was inpatient care (10 in total, 1mixed, 9 negative).

Themes

From analysis of the issues and concerns heard in Q2 of Year 2 of Healthwatch Bath and North East Somerset, the following themes have been identified:

(*these themes are likely to have emerged as a result of direct, targeted engagement with specific service user groups, as part of Healthwatch Bath and North East Somerset’s community development remit with priority groups in the area, and involvement in Healthwatch England’s first Special Inquiry into hospital discharge)

A perceived need for training in the needs of people who have autism*

Commentators report that health and social care professionals need to demonstrate increased awareness of the needs of people with autism, in order to ensure that services are meeting their needs. An example of this is that proformas used within services should be designed and used that a) enable people to identify themselves as having autism where necessary/appropriate, and b) meet the communication needs of people with autism.

A perceived need for improved communication between services and carers of people with mental ill health*

Commentators report a variety of issues they have experienced as carers of people with mental ill health. These include difficulties in navigating mental health services, for example being able to access services, being able to continue to access these services, and knowing how to address any issues or concerns they may have with those services.

In Year 1 Quarter 4, carers’ issues wasalso identified as a theme. This was more broad feedback but highlighted similar issuesreported by carers:

‘Several commentators have reported a lack of easily accessible information on care options and carers’ issues. They have identified a lack of signposting to this information, and reported difficulties in having to navigate the system to find out about, and gain clarity on, their options.’ (from Healthwatch Bath and North East Somerset Year 1 Quarter 4 Issues and Concerns report).

Discharge from secondary care*

A clear theme has emerged around the efficacy and efficiency of current discharge processes. An emerging ‘sub-theme’ is identifiable specifically in the context of maternity services. Commentators have reported a lack of information about after care following discharge, particularly following caesarean section procedures.

As mentioned above, the issues and concerns heard in Quarter 2 were collated as part of the Healthwatch England inquiry into hospital discharge. A report on the findings of this inquiry in the region covering Bath and North East Somerset, Somerset, South Gloucestershire and Bristol is available on the Healthwatch Bath and North East Somerset website: sets out the main results of the inquiry, which are based on issues and concerns heard in Bath and North East Somerset and by Local Healthwatch in the other 3 areas, which were triangulated and found to substantiate each other, resulting in the following key findings:

Approximately 90% of respondents received little or no Voluntary and Community Sector (VCS) support post-discharge. Many felt that an effective referral into the VCS would have improved their experience.
The discharge process should be quicker and more streamlined, with more effective planning.
The majority of respondents were happy with the quality of care they received but felt that they and their families/carers should have been more involved in their discharge process.
Complex discharge e.g. where a patient is moving into a care home, should be better managed to avoid gaps in medication provision etc.

Intelligence gathered from other organisations in Bath and North East Somerset corroborates with these findings. For example, the Sirona Health and Care Complaints and Concerns report (May 2014), identifies premature discharge from Sirona services as a theme emerging from their complaints data.

Next steps

Healthwatch Bath and North East Somerset will take this information to their partners, stakeholders, and to their Advisory Group, who will advise on any further work to be undertaken to investigate these themes further. Individual issues that have been ‘acute’ or ongoing at the time they were fed back to Healthwatch Bath and North East Somerset, have been considered by the Project Coordinator or Development Officer, and remedial action taken where necessary/possible/appropriate.

For 5 of the issues and concerns heard, we have been able to capture the specific ‘next steps’ taken by or advised to the commentator:

Table 1: Issues and concerns - next steps

Next step / No. of cases / Outcome
Signposted to advocacy / 3 / Unknown
Signposted to VCS organisation / 1 / Unknown
Forwarded to Bath and North East Somerset Council Safeguarding Team (Adults) / 1 / Email 28/8/14 from BathNES Council: Concerns being managed through the safeguarding process

Where issues and concerns heard in Quarter 2 specify a service, Healthwatch Bath and North East Somerset will contact the service provider and request a response on that issue or concern. Responses will be reported on in Quarter 3.

What we heard, who we told, what they did

Where issues in Quarter 1 specified a service, Healthwatch Bath and North East Somerset contacted the service provider and requested a response on that issue.

Of the 23 issues and concerns reported in Q1, the relevant service was identifiable from 7 comments. We wrote to the service commissioner and the responses gathered are detailed in Table 2 (page 6).

Table 2: What we heard, who we told, what they did

Issue/Concern / Organisation - Provider / Response
Commentator recounted an issue that she witnessed recently at RUH Audiology - a patient was upset because she thought that was due to have an appointment at Audiology, however it appeared that she was registered with Sirona. It took a long time for the hospital staff to sort it out; at one stage there were 4 members of staff trying to help, which was very annoying for other people that needed to book in. / Royal United Hospital Bath NHS Trust (RUH) / We would wish to apologise to the patient and the other people waiting to book into the Audiology clinic for this delay and any embarrassment caused to those present at the time. From the account quoted from the report, it does seem that several staff did at least try to help the patient with their appointment booking; the issue is that it was not carried out as efficiently as it might have been and this feedback will be relayed to the appropriate staff working in the Audiology team to ensure that they learn from the comment and make changes to practice in future. There are changes currently being made to improve the RUH Audiology service to patients.
Commentator raised a concern about their GP’s handling of a serious complaint. A meeting was arranged to discuss the matter, but the GP didn't seem to know the circumstances, he wasn't aware that any concerns that had been raised (despite the commentator having written a letter) and didn't really listen. A second, more formal meeting was arranged including a rep from SEAP, the GP, a senior nurse and the Practice Manager. Again the commentator felt that the Practice representatives didn’t listen, weren’t prepared (they seemed unaware of the commentator's letter written, or the circumstances surrounding her husband's case), they didn’t answer the commentator’s concerns, repeated themselves, and argued with her. The commentator wrote a similar letter to RUH, who immediately apologised and have taken steps to improve. They wanted to listen and learn from the commentator's experiences and she felt very reassured that every effort would be made to make sure her experience wouldn’t happen to other people. They showed her how they would use her experience to influence future care. / Royal United Hospital Bath NHS Trust (RUH) / Thank you for this positive feedback on the RUH response to the complainant. It is very helpful to know when a situation goes well, as well as when things require improvement and this feedback will be relayed to the relevant staff. There is currently a project taking place to improve the experience of people using the RUH complaints process, which includes patients and ex-complainants in the work that is progressing. We will use this positive feedback, as well as any other feedback that we receive on the complaints process, in order to continuously improve the service to patients and the public.
South Bristol Hospital have set up a system whereby community transport drivers can pass on their vehicle/ registration details, enabling them to park 'legally' in non-emergency ambulance bays when dropping off patients. This allows them to accompany patients into the building, particularly useful when transporting frail patients. / University Hospitals Bristol NHS Foundation Trust (UHB) / This initiative is in response to feedback from patients and carers living in more rural areas to enable them to access services at the hospital more easily.
Commentator had a routine mammogram and was told to arrive at the BRI for 2pm. Upon arrival she discovered it was a first come first served system so lots of people had turned up at 1pm to be at the front of the queue. Due to her position in the queue she wouldn't have been seen until 4.30pm, which meant she would be late to collect her children from school in BaNES. As a result she had to leave and was probably recorded as a no-show. / University Hospitals Bristol NHS Foundation Trust (UHB) / UHB are pursuing a response to this feedback.
The commentator’s husband woke in the night bleeding. They called 999 and an ambulance arrived. Patient was taken to RUH A&E, treated quickly, offered clear advice and discharged. GP promptly referred him to a specialist and an appointment was made for the following week at Southmead, available at a variety of times. The appointment was kept and an operation was booked - a very positive experience so far. The couple made their way to Southmead for the operation (5am start to get there for 7.30am) only to be told that the operation had been moved to the afternoon. The hospital were unable to say when in the afternoon it would take place, and in the meantime the husband was nil by mouth. The couple were offered the option of going home to return later but they live too far away. The couple spoke to other patients there who had also had their appointments changed. Commentator queries why appointment times are so thoughtless for those that live a long way away, and why hospitals have block appointments. / North Bristol NHS Trust (NBT) / A meeting is planned with NBT to discuss this response.
Commentator was under a Frenchay Hospital consultant for MS and has received a great service. / North Bristol NHS Trust (NBT) / A meeting is planned with NBT to discuss this response.
Commentator was under a Frenchay Hospital consultant for MS and has received a great service. Trying to find an effective painkiller has been very difficult, but for the last year she has found a method which has worked (1gm suppository of paracetamol). Harptree Surgery have said this approach is too expensive and won't let her have anymore. They suggested an alternative, which she has tried and found ineffective. The GP surgery have also tried to change her statin medication to a cheaper alternative, but again she has found this ineffective and has fought her case to remain on the same one. / NHS England – Bath and North East Somerset, Gloucestershire, Swindon and Wiltshire Local Area Team / If patients are not happy with a change in their brand of medication, they should talk to their GP who can advise on their condition, treatment options and medication issues. The other professional that people can gain advice from is the community pharmacist who will understand how the different medications are made up and work.
This NHS Choices article ( explains the national strategy to use non- branded medication when possible as this is an effective and efficient way for the NHS to better use its resources. Generally the active ingredients are the same across different medication brands, however, in rare cases the medication may not be as effective and in these circumstances it is a good idea for patients to discuss this with their GP or local pharmacist.